1679972632 NPI number — ANESTHESIA AT SYNERGY SPINE

Table of content: (NPI 1679972632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679972632 NPI number — ANESTHESIA AT SYNERGY SPINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA AT SYNERGY SPINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679972632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGH POINT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27261-6068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-447-7220
Provider Business Mailing Address Fax Number:
336-884-1643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
457 E BYPASS 123
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SENECA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-882-8850
Provider Business Practice Location Address Fax Number:
864-882-3420
Provider Enumeration Date:
08/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MCMILLAN
Authorized Official First Name:
MARION
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MEDICAL DIRECTOR / OWNER
Authorized Official Telephone Number:
864-882-8850

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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